9 Epiaortic Ultrasonography and Epicardial Echocardiography
Surface Imaging
Probe Orientation
Probe orientation marker is important for surface imaging techniques.

Figure 9-1 High-resolution TTE probe. A, Note the applied standoff and the raised mark on the right-hand side of the probe. B and C, Additional examples of standoffs (arrows) are noted.

Figure 9-2 Probe orientation. A, The images were acquired with the correct orientation. Asc, ascending. B, The probe has been rotated 90 degrees, and the SVC is on the opposite (i.e., incorrectly oriented) side of the screen.
Probe Options
Because the probe is close to the structure being imaged, a high-resolution (i.e., high-frequency) transthoracic or surface probe can be used to optimize images.
Image Acquisition and Optimization
Two operators are required to complete an ECE or EAU examination. The probe operator does not need experience to obtain the images; however, an expert intraoperative echocardiographer with advanced training should be available to guide image acquisition and interpretation.
Maintaining a Sterile Field
Use of a TTE for EAU and ECE imaging requires a sterile sheath to cover the probe and maintain sterility of the surgical field.

Figure 9-4 A, The sterile sheath is filled with saline. B, The echocardiographer inserts the probe within the sterile sheath. C, The operator inverts the probe within the saline to clear air from inside the standoff. D, The operator places the probe on the aorta, angling the probe toward the AV to start imaging.
Epiaortic Ultrasonography
Prevention of Stroke
Atherosclerosis of the ascending aorta and arch has been associated with perioperative stroke in cardiac surgical patients.
Key Points
Standard Views and 12-Segment Nomenclature
Key Points

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